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Портал Begell Электронная Бибилиотека e-Книги Журналы Справочники и Сборники статей Коллекции
Critical Reviews™ in Physical and Rehabilitation Medicine
SJR: 0.121 SNIP: 0.228 CiteScore™: 0.5

ISSN Печать: 0896-2960
ISSN Онлайн: 2162-6553

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Critical Reviews™ in Physical and Rehabilitation Medicine

DOI: 10.1615/CritRevPhysRehabilMed.2019030815
pages 157-171

Review of Lower Extremity Function Following SEMLS in Children with Cerebral Palsy

Rajani Mullerpatan
MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, India
Triveni Shetty
Department of Neurophysiotherapy, Mahatma Gandhi Mission School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
Sailaxmi Ganesan
Head of Therapy, Spastics Society of Tamil Nadu, Chennai, India
Ashok Johari
Pediatric Orthopedic Surgeon and Director, Children's Orthopedic Centre, MGM Institute of Health Sciences, Navi Mumbai, India

Краткое описание

Single-event multilevel surgery (SEMLS) is aimed at improving gait and motor function to optimize movement patterns, promote motor skill acquisition, and improve mobility. Literature informing comprehensive evaluation of post-surgical outcome based on the International Classification of Function (ICF) model (a standard framework for describing and organising information on functioning and disability) are lacking. We have summarized this review to guide clinical practice and have developed recommendations for future research. A literature search was performed in PUBMED, Google Scholar, and Cochrane database in July 2018. We included longitudinal, comparative, cross-sectional, prospective, retrospective, and systematic reviews reporting functional outcomes post-surgery with a mean follow-up period of minimum of 12 months on cohort of children aged 4−18 years with spastic cerebral palsy (CP) were included. We excluded articles reporting upper limb functional outcome, functional outcome of single surgical procedure, surgical approach, and functional outcome of only soft-tissue release. Of 43 extracted studies on post-surgical outcome, 16 met our inclusion criteria. According to the Physiotherapy Evidence Database (PEDro) scale, 4 articles were of high quality and 12 studies were of fair quality. SEMLSs demonstrated improvement in sagittal plane gait kinematics of all three lower extremity joints (hip, knee, ankle). Maximum improvement of approximately 5−28° was noted in minimum knee flexion (i.e., range of motion, ROM) during the stance phase. Improvement in gait profile score was maintained 5 years post-SEMLS. Mobility on functional mobility scale deteriorated at the first 6-month followup post-SEMLS, followed by an improvement at the 24-month follow-up. Postoperatively, self-care continued to improve over 18 months. Although improvement was reported in gait, mobility, and self-care, clinically meaningful improvement was not noted in quality of life. Our review suggests that, following SEMLS, improvement is reported in isolated outcome variables of function such as gait, mobility, and self-care. However, comprehensive evaluation of functional outcome needs further evaluation based on the ICF model.


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